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REGISTRATION FORM Ecological Consultants Association of NSW Annual Conference 2016 Monday 25th July at ‘The Briars’ 653 Mossvale Rd, Bowral New Insights in Ecology Name(s)___________________________________________________________________________________ (this will be the named displayed on your name tag) Business Name_____________________________________________________________________________ Address____________________________________________________________________________________ Phone___________________________________ Email_____________________________________________ Special dietary requirements___________________________________________ Early Bird Registration (before 30th June) □ $120 Member □ $150 Non-member □ $80 Student Late Registration □ $130 Member □ $160 Non-member □ $55 Dinner and Trivia Night □ $90 Student (must be paid in advance. Includes cocktail dinner, trivia and prizes, tea and coffee, other drinks not included. Partners welcome to attend dinner and trivia without attending conference) Total Enclosed_______________________ Payment method________________ PLEASE NOTE That this registration also forms an official tax invoice. ECA of NSW is not registered for GST. Ecological Consultants Association of NSW ABN: 85 213 648 549 Registration closes COB 2oth July 2016 and refunds will not be issued after this date.